5 reasons conventional doctors can’t fix your thyroid

I have spent countless hours over the last 5 years pouring over published studies on hypothyroidism. I have scoured the Internet every day searching for the very best thyroid experts and doctors. I have answered email after email and social media comments and posts from people struggling with hypothyroidism at all hours of the day and night. I have devoted my life to this blog that I created called Hypothyroid Mom. And you may wonder. Why?

Rage.

Yes I said rage.

On a cold, snowy day in New York City on January 20, 2009, I lay on a medical exam table on what would be one of the worst days of my life. I had miscarried at 12 weeks and was being prepared for a D&C, a surgical procedure to remove my baby. A technician had just taken an ultrasound and walked out of the room to reconfirm to the medical staff that my fetus had no heartbeat. I sprang off my bed and ran to the image on the screen. I felt my body shake and my fists clench as I stared at the image of my unborn child. From a place deep in my soul came a wail, “What happened to my child?”

I had unnecessarily lost my unborn baby all because my doctors had not read the Endocrine Society guidelines for pregnancy. Yes. Seriously. A TSH of less than 2.5 in the first trimester was clearly stated in the 2007 guidelines and mine was close to a whopping 10.0 with raging symptoms.

Why had I trusted my conventional doctors to have the answers?

Why had I not done my own research and been my own advocate?

Why had I not told my doctors to go to hell when they insisted that my symptoms were all in my head?

I should have fought like a ferocious lion for my child.

And I have to live with that regret for the rest of my life.

I will tell others.

I promised myself as I lay on that medical exam table.

I will let the world know.

I promised.

And Hypothyroid Mom was born.

I was determined to get to the bottom of this. I wouldn’t rest until I got myself well again and all my Hypothyroid Mom followers with me.

I searched high and low for thyroid experts when I first created Hypothyroid Mom in 2012. At that time there weren’t as many health experts and doctors writing about thyroid as there are today. I had to really search for the best information and I struck gold when I landed on this man.

Chris Kresser.

I hope he knows how many people he has helped. Including me.

I recently had a chance to connect with Chris and ask him some of my lingering thyroid questions. I know there is much written about thyroid but I wanted to dig deep into some of the issues that are not usually covered.

Written by Chris Kresser, M.S., L.Ac

1. The upper limit of the laboratory reference range for TSH is TOO high

Thyroid-stimulating hormone is the hormone that’s secreted by the pituitary gland, and its job is to tell the thyroid gland how much thyroid hormone to produce. The pituitary is kind of like the control tower that monitors thyroid hormone levels in the blood, and if they’re low, what it will do is produce higher amounts of TSH, or thyroid-stimulating hormone. On the other hand, if thyroid hormone levels are high in the bloodstream due to hyperthyroidism or maybe doses of thyroid medication that are too high, you’ll see TSH drop because the pituitary is naturally trying to limit the amount of thyroid hormone that’s produced by the thyroid gland.

Anytime you go to most conventional medicine physicians, and even if you just look at your lab results, you’re going to see that most commonly the reference range for TSH goes up to an acceptable limit of about 4.5.

How was the limit of 4.5 initially established?

The initial study was on the NHANES cohort, the Nurses’ Health Study. A lot of research has been done on that group, and not only did they not exclude people with undiagnosed hypothyroidism, they didn’t even exclude people with diagnosed hypothyroidism, which just seems crazy. So they took a whole bunch of people and they measured their TSH, but they included people with known and then undiagnosed hypothyroidism, which would skew the range much higher than it should be otherwise.

Then more recently, in the last 10 or 15 years, they’ve done studies where they excluded anyone with diagnosed hypothyroidism, which is just basic, but then they also used different methods of screening for hypothyroidism that didn’t involve TSH to determine whether people had undiagnosed hypothyroidism, and if they did, they excluded those people as well. And they basically found that a normal TSH for people that don’t have any thyroid problems is somewhere between 0.5 and maybe 2.2 or 2.5, depending on the study that you look at. As you can see, that’s very, very different than 4.5 being the upper end of the limit.

Lab markers are a snapshot in time, and you never want to rely exclusively on lab markers without assessing the entire clinical picture. And that’s especially true if we see people with thyroid symptoms or symptoms that could be attributed to poor thyroid function.

2. T4 to T3 conversion problems are NOT thyroid problems

T4 is 94% of what the thyroid gland produces in terms of thyroid hormones. Then that T4 has to get converted into T3, because T4 is not very active metabolically. T3 is the thyroid hormone that really activates the cellular receptors and does everything the thyroid hormone is supposed to do. So the thyroid gland produces most of the T4, and then elsewhere—not in the thyroid gland, but elsewhere around the body like the liver and the gut—that T4 gets converted into T3, which is the active form.

What we often see is people who have either normal or low normal T4, and then they have low T3. What that indicates actually is that the thyroid gland may be functioning okay, but the conversion of T4 to T3 that’s happening all around the body is not working well. That’s a really important thing to understand. T4 to T3 conversion problems are not thyroid problems. They’re not problems with the thyroid gland. They’re problems that are caused elsewhere in the body that affect the thyroid system. They affect the cell’s ability to receive T3 thyroid hormone. They’ll manifest in hypothyroid symptoms, but they’re not actually a problem with the thyroid gland. It’s crucial to understand that, because it completely informs how we address T4 to T3 conversion problems.

For example, giving the patient a whole bunch more T4 medication is probably not a great idea in that situation, because the T4 is not being converted into T3. But that’s the standard treatment for a lot of thyroid problems, is just to give Synthroid or levothyroxine, which is a T4-based medication.

So what’s going wrong in this situation? It’s usually three primary causes: inflammation, poor gut health, and very low-carb diets.

3. Sensitivities to thyroid medication are OVERLOOKED

Another common question that is hotly debated is whether bio-identical or synthetic hormones are best. The answer is: “It depends.” In general I think bio-identical hormones are the best choice. A frequently perpetuated myth (in Synthroid marketing, for example) is that the dosages and ratio of T4:T3 in Armour aren’t consistent. Studies have shown this to be false. Armour contains a consistent dose of 38 mcg T4 and 9 mcg T3 in a ratio of 4.22:1.

However, in some cases patients do feel better with synthetic hormones. One reason for this is that a small subset of people with Hashimoto’s produce antibodies not only to their thyroid tissue (TPO and TG), but also to their own thyroid hormones (T4 and T3). These patients do worse with bio-identical sources because they increased the source of the autoimmune attack.

Another important consideration in choosing the right hormone is the fillers contained in each medication. Many popular thyroid medications contain common allergens such as cornstarch, lactose and even gluten. Most hypothyroid patients have sensitivities to gluten, and many of them also react to corn and dairy (which contains lactose).

Synthroid, which is one of the most popular medications prescribed for hypothyroidism, has both cornstarch and lactose as a filler. Cytomel, which is a popular synthetic T3 hormone, has modified food starch – which contains gluten – as a filler.

Even the natural porcine products like Armour suffer from issues with fillers. In 2008, the manufacturers of Armour reformulated the product, reducing the amount of dextrose & increasing the amount of methylcellulose in the filler. This may explain the explosion of reports by patients on internet forums and in doctor’s offices that the new form of Armour was either “miraculous” or “horrible”. Those that had sensitivities to dextrose were reacting less to the new form, and experiencing better results, while those that had sensitivities to methylcellulose were reacting more, and experiencing worse results.

The best choice in these situations is to ask your doctor to have a compounding pharmacy fill the prescription using fillers you aren’t sensitive to. Unfortunately, insurance companies sometimes refuse to cover this.

4. Studies show that 90% of people with hypothyroidism are producing antibodies to thyroid tissue

90%of people with hypothyroidism are producing antibodies to thyroid tissue. This causes the immune system to attack and destroy the thyroid, which over time causes a decline in thyroid hormone levels.This autoimmune form of hypothyroidism is called Hashimoto’s disease.

Most doctors know that the majority of hypothyroidism is an autoimmune disease. But most patients don’t. The reason doctors don’t tell their patients is simple: it doesn’t affect their treatment plan. Conventional medicine doesn’t have effective treatments for autoimmune disease.

The standard of care for a Hashimoto’s patient is to simply wait until the immune system has destroyed enough thyroid tissue to classify them as hypothyroid, and then give them thyroid hormone replacement. If they start to exhibit other symptoms commonly associated with their condition, like depression or insulin resistance, they’ll get additional drugs for those problems.

The obvious shortcoming of this approach is that it doesn’t address the underlying cause of the problem, which is the immune system attacking the thyroid gland.

What the vast majority of hypothyroidism patients need to understand is that they don’t have a problem with their thyroid, they have a problem with their immune systemattacking the thyroid. This is crucial to understand, because when the immune system is out of control, it’s not only the thyroid that will be affected.

Hashimoto’s often manifests as a “polyendocrine autoimmune pattern”. This means that in addition to having antibodies to thyroid tissue, it’s not uncommon for Hashimoto’s patients to have antibodies to other tissues or enzymes as well. The most common are transglutaminase (Celiac disease), the cerebellum (neurological disorders), intrinsic factor (pernicious anemia), glutamic acid decarboxylase (anxiety/panic attacks and late onset type 1 diabetes).

5. Antibody tests are NOT reliable in diagnosing Hashimoto’s

The first-line test you do for Hashimoto’s, typically what I do, is antibodies. By antibodies, I mean thyroperoxidase and thyroglobulin antibodies, these are the two antibodies that tend to be elevated in Hashimoto’s. Thyroperoxidase is elevated a lot more often than thyroglobulin.

I know some practitioners will say anything above zero is abnormal, but I don’t actually think that’s true. A small amount of antibody production is actually not pathological or abnormal. I do use the lab range. If it’s getting close to the top of the lab range, I will definitely be paying attention, because the cutoffs are always somewhat arbitrary. They’re based on research and prospective studies, and I’ve seen some prospective studies that suggest to me that the lab range should be, perhaps, a little bit lower than it is.

The problem with thyroid antibodies is, like almost any lab test that you can mention, they’re not 100% reliable as a way of diagnosing Hashimoto’s. For example, in a study of 100 South Asian Indian people that had Hashimoto’s confirmed by histological analysis—meaning actually looking at the tissue and seeing for sure that they have Hashimoto’s—about 89% had TPO antibodies and 65% had thyroglobulin antibodies. That means that 11% of people with Hashimoto’s would have been missed if you were only looking at TPO antibodies, and a full 35% of patients with Hashimoto’s would have been missed if you were only looking at thyroglobulin antibodies. What we can say from these numbers is that anywhere between 11% and maybe 30% of patients, if you run TPO and thyroglobulin antibodies that have negative results on an antibody test, may still have Hashimoto’s, even if you run that antibody test multiple times. So that’s really important for clinicians to understand, because I’ve seen a lot of patients who’ve been to the doctor a few times before they came to see me. They said, “No, I don’t have Hashimoto’s. I had an antibody test, and it was negative.” Well, you can’t really conclusively rule it out just from an antibody test or two.

I always recommend that people do two to three tests over time at least, to see if we can catch it. And I have seen that with patients, where they’ve come and they’ve had one or two negative tests. I test them a third or fourth time, and we catch the antibodies elevated on the third or fourth time.”

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Dana Trentini M.A., Ed.M., founded Hypothyroid Mom October 2012 in memory of the unborn baby she lost to hypothyroidism. This is for informational purposes only and should not be considered a substitute for consulting your physician regarding medical advice pertaining to your health. Hypothyroid Mom includes affiliate links including the Amazon Services LLC Associates Program. Connect with Dana on Google+

Comments

I can’t believe how similar our stories are. I am so sorry for your loss. And great job informing yourself and taking over your own health. Your are doing a great job sharing information with others. Knowledge is power!

I’ve been on LDN for a year, my numbers are still high,in particular my cardiac AB are high and that is scary that my body is attacking my heart. At what point do I encorporate both an endocrinologist and a nature path together to try and get this under control

Hi Jessica, Given that you are talking about heart issues, I would personally seek multiple medical opinions from different points of view to hear all the possible alternatives. Good to have you at Hypothyroid Mom.

My labs always show low T3. I’ve tried every form of T3 available and I get horrible insomnia. Even at low doses. I’m so tired of being tired and not doing the things I love. I can only tolerate synthroid. Any insight?

Hi Sandy, There are three common reasons why some people react poorly to T3 medications that you should look into. First, if I take my T3 medications too close to the late afternoon, I can’t sleep. I take mine no later than 2pm. The other two things to have your doctor check: your adrenals (saliva testing to measure cortisol) and full iron panel. Good to have you at Hypothyroid Mom.

i was diagnosed on my 50th birthday with hasimoto…I was put in the hospital also with fatty liver disease…i spent 3 weeks being poked and prodded…mri scans..i hated it…they finally put me on levothroid…1.5 mg..the doctor says im doing fine according to the tests…but i feel lethargic all the time…had to go on disability which pays very little…i watch and read all kinds of articles and tv shows for answers…i want my life back….but for guy its a slow process..any tips how to deal with my situation would be appreciated…

I bought a book by the Medical Medium, Anthony William on Thyroid and he explains that your thyroid is being attacked by the EBV (Epstein-Barr virus) at some point that entered your body. he recommends to cut out wheat gluten, dairy (especially eggs), pork, canola oil, corn and soy. Also recommends getting tested or thyroid anitibodies (TPO). thyroid meds don’t heal thyroid, they help with symptoms we all have here. I am going to try to detox the heavy metals and all other impurities via special juices added to my diet in the book and we shall see. It’s a good read.

I’ve had Hashimoto’s that originally presented as just hypothyroid as that’s all that was tested since 1989 after the birth of my second child. It wasn’t diagnosed till 2014 (via lab tests for antibodies etc.) when my weight went up suddenly, hair fell out section by section till nearly bald let alone all over my body, fatigue, brain fog and insomnia (since 2006). Doctors said it was probably ‘just’ perimenopause. Anyway, I’ve done EVERYTHING suggested in all the providers books, including the Medical Medium, Wentz, Dr K etc. Even went off wheat/eggs/gluten/dairy for a year w/o improvement- in fact, my antibodies ALL increased! The latest ‘fad’ in thyroid treatment is to just use T3, one reason being that T4 is converting to reveres T3 now. My antibodies remain about the same. I dutifully take all the supplements, get in daily hikes/light snowshoes/walks but only for 45-60 minutes due to my severe spinal stenosis which got worse from a 2014 fall (originally fell and hurt my lower back in 1972), and only eat up to 100 whole grain carbs a day and 1 apple to control blood sugars, and eat healthy fats like avocado/olive oil. I do not eat the typical SAD and haven’t since 1973. I’ve had toxins tested etc. I’ve had mold tested. I’ve even spent hundreds on Lyme testing (came out negative). So my latest naturopath and I are working on titrating a good enough dose of T3 for me, bit by bit as trying plain T3 at 25 mcg alone 2x a day produced adverse symptoms within a few days- like feeling like I was on speed and kept me awake for a few days. I’ve also done adrenal testing (blood and saliva which conflict in results) and am now titrating cortisol. I had to retire from work early at 61 2 years ago and forgo getting full social security and am in the very long process of applying for SSI, being rejected twice already (which is typical). My actual in person hearing is this July. The additional $300/400 a month would really help me afford my T3, cortisol, and acupuncture, which insurance doesn’t cover. Next year I’ll be 64 and Medicare doesn’t cover acupuncture. Without acupuncture, I wouldn’t be walking as the pain is referred pain down the back thighs. I can’t sit/stand for more than 30 minutes at a time. Getting to medical appointments ( 1 1/2 hr drive each way) is very difficult and my husband always has to drive as I never know when a stabbing muscle pain will hit. So, does ANYONE have any other concrete suggestions? At this time, I spend 7 hours sleeping at night (finally!), 2-3 hours napping nearly every afternoon as my brain literally shuts down (whether or not I do my hike/snowshoe that morning or not), and spend 15 hours of the 24 flat reading or watching TV these past 3 years and I’ve NEVER been a big TV watcher!

Hi,I’d like to know what being on a low carb diet has to do with hypothyroidism please?I have had my thyroid removed because of cancer and am on thyroxine replacement.My doctor keeps telling me to lower my dose because of the lab results for the tsh , but I feel great where they are.Mystery?This is the first time I have heard of this.I hope my question is not too hard for you

Hi,I’d like to know what being on a low carb diet has to do with hypothyroidism please?I have had my thyroid removed because of cancer and am on thyroxine replacement.My doctor keeps telling me to lower my dose because of the lab results for the tsh , but I feel great where they are.Mystery?

Hi. I have Hashimoto disease. My doctor recommended I remove gluten from my diet and he prescribed a diabetic medication called Metformin. My systems were very much like others, tired all the time, gaining weight a a rapid pace, Hot flashes, hard time falling g asleep, etc. Have you heard of anyone taking this drug before? I did cut out gluten and dairy. I just want to have my life back!

I was diagnosed with Hashimoto’s 2 years ago and finally found relief with Armour Thyroid and a bevy of supplements. However, over a 5-year period, I’ve lost 2/3s length of my hair with absolutely no new growth. The condition of the hair is good, just breakage and no growth. Iron, biotin, zinc, selenium, hair vitamins have had no effect.
I could use help from Dana and this community. Thanks.

Hi Danya, I was losing hair in clumps that it scared me so much I spent over one year researching the causes of hair loss to thankfully stop mine. Now I have long full hair and most of the scalp showing is filled up with hair. This article that I wrote is one of the most popular at my site.

Hi Pamela, I’m so sorry to hear about your hair. I know how devastating it is to see wads of hair falling out. There are many things to consider for your hair loss. Here is one of most popular articles on my site: